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Association of Troponin Elevation with Risk of Mortality in Acute Coronary Syndromes

%. %. %. Mortality at 42 Days. %. %. %. 831. 174. 148. 134. 50. 67. . Association of Troponin Elevation with Risk of Mortality in Acute Coronary Syndromes. Antman EM. N Engl J Med 1996; 335: 12342-1349. Audience Poll.

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Association of Troponin Elevation with Risk of Mortality in Acute Coronary Syndromes

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  1. % % % Mortality at 42 Days % % % 831 174 148 134 50 67  Association of Troponin Elevation with Risk of Mortality in Acute Coronary Syndromes Antman EM. N Engl J Med 1996; 335: 12342-1349.

  2. Audience Poll • What is the most powerful predictor of the patient’s troponin status? Circulation 2002;106:202-207

  3. The Presence of A Stained or Closed Muscle on Diagnostic Cath Circulation 2002;106:202-207

  4. Troponin T & Angiographic Findings P=0.021 P=0.007 P=0.0003 P=0.03 % Normal TMPG 3 % Thrombus % Stenosis % Vessel Occlusion tnT - tnT + tnT - tnT + tnT - tnT + tnT - tnT + Even when epicardial TIMI flow grade and the presence of thrombus were adjusted for, the presence of a closed microvasculature was independently associated with tnT elevation in a multivariate model (O.R. 1.79, p=0.017). Circulation 2002;106:202-207

  5. Peak [tnT] and [tnI] by TIMI Myocardial Perfusion Grade (TMPG) status P=0.007 P=0.006 Tn I (ng / mL) tn T (ng / mL) TMPG 2/3 TMPG 0/1 TMPG 0/1 TMPG 2/3 Circulation 2002;106:202-207

  6. Troponin Elevations on Admission are Associated with Tissue Level Perfusion Following PCI: TACTICS TIMI 18 p=0.004 p=0.013 % TMPG 0/1 % TMPG 0/1 Circulation 2002;106:202-207

  7. Event Free Survival is Associated with Tissue Level Perfusion in UA / Non Q Wave MI: TACTICS – TIMI 18 P = 0.018 % TMPG 3 TMPG 2/3 Pre or Post-PCI Slow Normal N = 253 N = 253 p=0.026 “Upstream” Duration (> median) TMPG 0/1 Pre & Post PCI Event Free Survival Gibson. Am J Cardiol. 2004; 94:492-4 Stain Pale • Impaired tissue perfusion on diagnostic cath is associated with Tn + and adverse outcomes • Earlier upstream initiation of GPIIbIIIa inhibition is associated with improved tisse perfusion om diagnostic cath Days Circulation 2002;106:202-207

  8. 100 100 80 80 60 60 40 40 20 20 0 0 Thrombus Is Less Common and Flow Is Better With Upstream GP IIb/IIIa Use Overall Odds Ratio: 0.77 P=0.022 Fresh occlusion TIMI Flow Medium or large thrombus Grade 3 Grade 2 % Patients Possible or small thrombus Grade 1 Grade 0 No thrombus Heparin Alone Tirofiban + Heparin Heparin Alone Tirofiban + Heparin Zhao et al. Circulation. 1999;100:1609-1615.

  9. 30 30 25 25 20 20 15 15 10 10 5 5 0 0 Long-Term Benefit of Upstream Therapy in Reducing Thrombus and Improving TIMI 3 Flow Events at 30 Days Thrombus TIMI 0-2 (n=298) No thrombus TIMI 3 (n=1095) 20% Patients With Event (%) 12% 10% 9% 7.4% 5.5% Composite MI/Death Refract Isch Composite MI/Death Refract Isch Hazard ratio P value 1.72 <0.001 1.44 0.08 1.68 0.02 1.72 <0.001 1.44 0.08 1.68 0.02 Zhao et al. Circulation. 1999;100:1609-1615.

  10. 5.3 % * NRMI also shows that early GP IIb-IIIa inhibitor therapy reduces in-hospital mortality P < 0.001n = 32,710 8.5 % In-hospital Death 3.2 % GP IIb-IIIa Inhibitor < 24 Hrs. GP IIb-IIIa Inhibitor > 24 Hrs. * Unadjusted for risk. Peterson E. Presented at ACC. March 2002.

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